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Diabetic retinopathy (DR) and diabetic macular edema (DME) present a serious medical and social issue of modern society. DME is one of the most common complications of DR and a frequent cause of a sudden decrease in visual acuity and the onset of disability. The review describes the main links of DME pathogenesis, including the participation of inflammatory cytokines, glycation products, reactive oxygen species, vascular endothelial growth factor and various cellular damages. The existing classifications of the disease, instrumental methods of diagnosis and treatment are presented, primarily those using angiogenesis inhibitors alone or in combination with laser treatment and intravitreal injection of an implant with dexamethasone. Various methods of surgical treatment of DR, which can impact the course of DME, are analyzed, including vitreoretinal surgery using vitrectomy with or without membrane peeling of the internal limiting and epiretinal membranes. Factors predicting the effectiveness of these surgical interventions are listed: these can be based on the general somatic condition of the patient and on the results of optical coherence tomography.

This narrative review examines current and emerging treatment strategies for diabetic macular edema (DME), a complication of diabetic retinopathy characterised by fluid accumulation in the macula, which can lead to vision impairment. The incidence of DME is particularly high in patients with long-standing diabetes and advanced retinopathy. The current treatment options for DME include anti-vascular endothelial growth factor (anti-VEGF) agents, corticosteroids, and laser therapies. Anti-VEGF agents, including bevacizumab, ranibizumab, aflibercept, and the more recently developed brolucizumab and faricimab, have been demonstrated to reduce macular thickness and improve visual acuity. Brolucizumab offers the advantage of fewer injections due to its longer duration of action, although it carries a higher risk of ocular inflammation compared to other anti-VEGF agents. The dual inhibition of the VEGF and angiopoietin-2 (Ang-2) pathways by faricimab may enhance vascular stability and reduce inflammation, potentially improving patient outcomes. Steroid therapies, including dexamethasone, fluocinolone acetonide, and triamcinolone acetonide, represent an alternative for patients who do not respond adequately to anti-VEGF treatment. Laser therapies, including focal, navigated, and subthreshold laser treatments, remain a crucial component in the management of DME, with the ability to seal leaking vessels and reduce fluid accumulation. In order to achieve the best outcomes for patients, it is essential to continue to advance these treatment modalities and adopt a personalised, multifaceted approach.

The aim of the study was to evaluate the efficacy and safety of brolucizumab in the Russian population of patients with diabetic macular edema. Patients and methods: 41 patients (29 women and 12 men) with diabetic retinopathy and diabetic macular edema of comparable age were included in the study. The patients were divided into 2 groups depending on the previous DME treatment. The first group included 24 patients (24 eyes) who had not previously received treatment: 9 men and 15 women, the average age of patients was 62.9 ± 9.3 years, the average best-corrected visual acuity was 0.40 ± 0.23, CTS 332 ± 87 microns, MV 9.65 ± 1.2 mm3. There were 17 patients (17 eyes) in the second group, they had previously received other antiangiogenic drugs, but retained the activity of the disease against the background of the treatment (1 man and 16 women), the average age of patients was 60.6 ± 8.3 years, the average best-corrected visual acuity was 0.40 ± 0.27, CTS 351.6 ± 149.0 microns, MV 9.3 ± 1.8 mm3. All patients received at least 5 intravitreal injections of brolucizumab (205 injections in total) at intervals of 6 weeks. The control examination was carried out 6 weeks after the last injection and a month after the fifth injection. The best-corrected visual acuity, intraocular pressure, central retinal thickness (CTS), macular volume (MV) were evaluated according to optical coherence tomography. Results. In the first group, a statistically significant increase in the best-corrected visual acuity was revealed from 0.40 ± 0.23 to 0.575 ± 0.27 (p = 0.05), the indicators of CTS and MV statistically significantly decreased. In the second group, only a decrease in CTS was detected, while the indicators of BCVA and MV did not show statistically significant changes. Conclusion. Patients with DME, who were treated with brolucizumab and who had not previously received treatment with other drugs, showed an improvement in anatomical and functional parameters, patients, who retained the activity of the disease against the background of the treatment, showed a slight decrease in the activity of the disease.

Objectives: to evaluate the dynamics of changes in quality of life in patients with diabetic macular edema (DME) with vitrectomized and non-vitrectomized eyes after intravitreal injection of dexamethasone implant (IVD). Material and methods. 60 patients (60 eyes) were examined, divided into two groups with a diagnosis of diabetic retinopathy, DME and with different vitreous conditions. Group 1 — patients with non-vitrectomized eyes, group 2 — with vitrectomized eyes. Both objective and subjective methods of ophthalmological examination were used, followed by an assessment of the quality of life and visual functions based on the results of a questionnaire conducted to patients using VFQ-25 (visual function questionnaire — 25). Also, all patients of both groups were assessed for best corrected visual acuity (BCVA) before, 1, 3 and 6 months after IVD. Results. In both groups, an increase in the average BCVA after IVD was observed up to 3 months of monitoring (p < 0.01). In addition, the quality of life parameters increased after 1 month of steroid therapy in both groups (p < 0.05), and by 3 and 6 months this trend persisted mainly only for the group with vitrectomized eyes (p < 0.05). Conclusion. IVD in patients with DME can significantly improve the morphofunctional parameters of the macular zone in the eyes with both vitrectomized and non-vitrectomized eyes. The maximum effect of the drug according to the quality of visual functions assessment was observed in 1 month of monitoring in the group with non-vitrectomized eyes. At the same time, the longest increase in quality of visual functions parameters from 3 to 6 months was observed in the group with vitrectomized eyes.

The importance of early detection and monitoring of retinal diseases determines the relevance of the study devoted to the diagnosis of retinal pathologies by OCT images using artificial intelligence (AI) tools.The purpose is to develop algorithms for diagnosing retinal pathologies from OCT images by machine learning methods.Material and methods. The study used a dataset (20,000 eyes), publicly available on the Internet, which contains OCT images of healthy retina (5,000 eyes) and retina affected by three different pathologies (choroid neovascularization, macular edema, multiple drusen, 15,000 eyes). The retinal pathology recognition system is based on a trained neural network VGG16 (developed by a visual geometry group of Oxford University).Results. The main result of the research is the development of an algorithm, implemented on Python, for the diagnosis of retinal diseases from OCT images based on convolutional neural network AI tool. The sensitivity and selectiveness of the neural network model during the diagnosis of retinal diseases were 97 and 98%, respectively.Conclusion. AI methods used in the retinal pathology automatic detection system developed at the Helmholtz National Medical Research Center of Eye Diseases as part of automated medical decision-making system have been shown to have high potential and efficiency. In the future, this service can be used to improve the effectiveness of early diagnosis and monitoring of retinal diseases in conditions of reduced availability of primary ophthalmological care in some of the territories of the Russian Federation, including that provided at the pre-doctoral stage.

Purpose: to analyze intraocular fluid (IOF) cytokine concentrations in patients with diabetic macular edema (DME) after intravitreal therapy with angiogenesis inhibitors or corticosteroids (CS).Materials and methods. 44 patients (45 eyes) were divided in 2 groups depending on the therapy: group 1 (n = 19) received an angiogenesis inhibitor (aflibercept) while group2 (n = 26) received CS (dexamethasone implant). They were tested for IOF cytokine levels by Milliplex® Map Human Cytokine/Chemokine Panel at treatment start and 3 months after either 3 monthly injections of aflibercept or a single dexamethasone implant injection.Results. The concentrations of ten cytokines (IL-8/CXCL8, IP-10/CXCL10, MCP-1/CCL2, PDGF-AA, GROα/CXCL1, VEGF-A, MIP-1β/CCL4, IL-15, IL-7, IL-6) were found to fall significantly in both groups of therapy. IL-6 and IL-5 levels showed the most significant drop as compared to other cytokines, with a more pronounced decrease in the aflibercept treatment group. In both groups, VEGF-A concentration showed a significant drop, and the share of the eyes that responded to the treatment was 94.7 % in the aflibercept therapy group and 96.2 % in in the dexamethasone implant group.Conclusion. The IOF concentration assessment of a number of pro-inflammatory cytokines/chemokines shows that both the anti-VEGF agent — aflibercept and CS — dexamethasone implant contribute to a decrease of inflammation which is observed 3 months after the start of treatment.

Purpose: to analyze the levels of cytokines in intraocular fluid (IF) and blood plasma of patients with diabetic macular edema (DME) previously untreated by intravitreal therapy before and after the therapy by angiogenesis inhibitor or a corticosteroid. Material and methods. We examined 90 people — 47 females (52.2 %) and 43 males (47.8 %), mean age 64.54 ± 11.30 years. Of these, 60 had DME, and 30 formed the control group. The levels of 41 cytokines/chemokines in IF were determined by Milliplex® Map Human Cytokine/ Chemokine Panel; while the concentration of IL-18, MCP-1/CCL2, EPO, IL-10, IL-4, IL-6, IL-8, IFNα, VEGF-A in blood plasma was measured by enzyme-linked immunosorbent assay kits (Vector-Best, Russia). Patients with DME received intravitreal injections of an angiogenesis inhibitor (aflibercept. 50 eyes) or a corticosteroid (dexamethasone implant, 30 eyes). Results. Significant differences were revealed in 10 cytokine concentrations between the DME patients and the control group. The concentrations of IL-7, IL-15 and MCP-1/CCL2 levels in IF of DME patients were, respectively, 20.5, 20.3, and 11.02 times higher, than in the control group (р ˂ 0.05). Besides, a pairwise comparison of cytokines concentrations in IF of patients from either treatment group with the controls demonstrated a statistically significant increase in GROα/CXCL1 level. The pairwise comparison also revealed significant differences between the control and the corticosteroid therapy for systemic concentrations of IL-18 (p = 0.017), MCP-1/CCL2 (p = 0.009) and VEGF-A (p = 0.016). Conclusion. A pronounced and significant increase of the levels of a number of cytokines (e.g., IL-7, IL-15. FRACTALKINE/CX3CL1) were only sparsely reported before or remained undetermined at all. Our results on systemic cytokines levels may serve as prerequisite for further research into the role of systemic inflammation in DME pathogenesis. The analysis of associations of our results with those of other clinical biomarkers will contribute to the development of individualized treatment strategies.

Today, between 230 and 347 million people on the planet suffer from diabetes, which is approximately 6 % of the all adult population. Diabetic macular edema (DME) can occur at any stage of diabetic retinopathy (DR), and remains the most common cause of moderate vision loss in patients with DR, due to increased retinal vascular permeability leading to accumulation of extracellular/intracellular fluid and blood plasma components in the neurosensory retina. The use of objective, quantifiable medical signs, called biomarkers, has become more relevant in clinical practice and clinical research. They allow the identification of a normal biological or pathological process, becoming clinical and diagnostic tools in routine clinical practice. Over the past decade, there has been significant progress in the treatment of macular edema, but the search for a more effective method does not stop. Modern research is being carried out in the direction of creating new drugs and increasing the intervals between injections. New molecules target previously studied as well as new targets. The pharmaceuticals used are investigating at higher doses and different delivery methods. Viral vectors and new phototherapeutic agents are currently being tested. This wide range of research studies, with several therapeutics currently in phase 3, could lead to impressive results in the treatment of diabetic retinopathy in the not too distant future.

Purpose: to evaluate the clinical efficacy of subthreshold laser treatment of focal DME in continuous and micro-pulse modes using a navigation system based on OCT-A data.Methods. 33 patients (33 eyes) with focal DME were under observation before and after laser treatment. All patients underwent high-resolution OCT-A using the HD Angio Retina 6×6 mm protocol on RTVue-100 XR Avanti (Optovue, USA) and SOLIX (Optovue, USA) devices. The height of edema in the fovea averaged 304.5 ± 5.4 um in the group, in the area of edema outside the fovea — 336.5 ± 7.5 um. The initial best corrected visual acuity (BCVA) was 0.75 ± 0.06. The central retinal sensitivity (CRS) before treatment was 24.10 ± 0.48 dB. The treatment was carried out on the NAVILAS 577S navigation laser system (“OD-OS”, Germany). The results were evaluated within 1, 3 and 6 months after treatment.Results. 1 month after laser treatment, the average CRT in the group was: in the fovea — 294.00 ± 5.38 um, outside the fovea — 318.50 ± 6.44 um. The BCVA increased on average to 0.80 ± 0.06; the CRS to 24.65 ± 0.47 dB. After 3 months, a further decrease in the height of edema was observed (CRT in the fovea was 252.50 ± 2.19 microns, outside the fovea 280.50 ± 3.75 microns). The BCVA increased on average in the group to 0.85 ± 0.06, CRS — 25.50 ± 0.30 dB. After 6 months, the average CRT in the group was: in the fovea — 246.50 ± 1.81 microns, outside the fovea — 273.50 ± 4.56 microns. A stable increase in the BCVA indicators was achieved — 0.85 ± 0.06 and CRS — 26.65 ± 0.16 dB. At the time of 1.3 and 6 months after treatment, an increase in vascular density was observed in the deep vascular complex and the superficial vascular plexus.Conclusion. The preliminary results obtained by us indicate the effectiveness of navigation sub-threshold laser treatment of DME in the micro-pulse and continuous modes, based on targeted topographicallyoriented laser exposure according to OCT angiography.

The Navilas 577 laser system integrates a laser coagulator with a tracking system and a fundus camera. The system ensures operation planning and representing the results of optical coherence tomography on the fundus image, which makes the treatment fast, clearly observable and safe and minimizes damage to healthy tissues.Purpose. To compare the results of threshold laser coagulation in the treatment of DME using a Navilas 577 laser and a Quantel Medical 532 nm device.Materials and methods. 64 patients aged 41–80 (64 eyes) with DME less than 350 μm high were examined after intravitreal administration of angiogenesis inhibitors and threshold lattice laser coagulation using Quantel Medical 532 and Navilas 577.Results. A lower height of the edema and an increase in visual acuity were observed in both cases, but in the Navilas 577 laser group the BCVA was higher than in Quantel Madical 532, whilst the edema height in the Navilas 577 laser group in the central fovea area was less high.Conclusion. 1. The combination of retinal laser coagulation and angiogenesis inhibitors in the treatment of low DME (less than 350 μm) provides good results, so it can be justified and expedient in real clinical practice. The efficiency of 577 nm navigation laser exposure was found to be higher than that of threshold 532 nm laser coagulation.

Purpose — to study visualized biomarkers before and after navigation laser treatment in patients with diabetic macular edema (DMO) using optical coherence tomography-angiography (OCT-A).Methods. 85 patients (85 eyes) with focal DMO were under observation. The patients were divided into two groups, depending on the method of laser treatment used: group 1 consisted of 50 patients (50 eyes) who underwent navigation sub-threshold laser exposure in micro-pulse and continuous modes with individual selection of energy parameters according to the developed technology (patent RF for invention No. 2752544 of 27.01.2021), in group 2 (35 patients, 35 eyes) laser coagulation was performed according to the type of “modified grid”. The treatment was carried out on the NAVILAS 577S navigation laser system (“OD-OS”, Germany). All patients in both groups underwent high-resolution OCT-A according to the Angio Retina 3×3 mm and HD Angio Retina 6×6 mm protocol. The following biomarkers were evaluated by the OCT-A method: vascular density of the superficial vascular plexus (SCP), deep vascular complex (DCP); the number of microaneurysms and hyperreflective points; the area of the foveal avascular zone, as well as cysts and zones of disorganization of the inner layers of the retina (DRIL), at various times before and after (1, 3 and 6 months) treatment.Results. According to OCT-A, as a result of treatment in group 1, there was an increase in total vascular density from 38.45 ± 0.4 % to 44.85 ± 0.66 % in SCP and from 43.55 ± 0.38 % to 44.85 ± 0.66 % in DCP by 6 months of follow–up. In group 2, the total vascular density in SCP increased from 37.4 ± 0.36 % to 37.85 ± 0.34 %, in DCP from 43.35 ± 0.38 % to 44.05 ± 0.41 %. The number of microaneurysms decreased on average from 12 ± 0.42 to 9 ± 0.3 by 3 months and 7.5 ± 0.26 by 6 months in group 1 and, from 19 ± 0.7 to 15.5 ± 0.6 (3 months) and 13 ± 0.5 (6 months) — in group 2. The number of hyperreflective points decreased in terms of 3 and 6 months in both groups. The area of cysts progressively decreased, and the area of FAZ and DRILS was stable throughout all the follow-up period.Conclusion. OCT-A is a highly informative diagnostic method that allows noninvasively to identify visualized OCT-A biomarkers, as well as to evaluate the effectiveness of navigation laser exposure in patients with diabetic maculopathy with focal diabetic macular edema.

The density of macular pigment in the central retina is the total concentration of lutein, zeaxanthin and meso-zeaxanthin. Normally, the average value of the optical density of macular pigment can vary significantly as it depends on the person's lifestyle, the total amount of pigment in the body, nutrition, gender, age, as well as concomitant diseases such as diabetes, obesity, arterial hypertension. Differences in the level of optical density of macular pigment between different countries were revealed and it was showed that this parameter drops in cases of retinal pathology, cataract, glaucoma, myopia, macular degeneration, or diabetic macular edema. The level of macular pigment may be considered as a significant diagnostic criterion in many ophthalmic pathologies, so any changes of this parameter require attentive consideration.

The purpose of the study was to assess the changes of biomarkers of diabetic macular edema activity by optical coherence tomography angiography (OCTA) data and the relationship of these biomarkers with the response to anti-VEGF therapy during a two-year follow-up. Material and methods. The study included 59 patients (101) eyes, averagely aged 60.27 ± 9.50 years. The average number of intravitreal injections of aflibercept over the treatment period was 12.87 ± 3.50. The initial size of the foveolar avascular zone (FAZ) area — 0.37 ± 0.22 mm2 , and the acircularity index — 0.56 ± 0.14 remained unchanged after 5 months: 0.36 ± 0.24 mm2 and 0.56 ± 0.12, respectively, and being practically in the same level in 12 and 24 months. The large FAZ area, noted in the group where disorganization of retinal inner layers (DRIL) was observed (0.39 ± 0.21 mm2 ), correlated with a lower visual acuity (r = 0.67, p = 0.003). The acircularity index remained unchanged; no significant differences were found in the DRIL patient groups. After 5 loading injections, the average initial density of vessels in the macular region increased from 12.33 ± 3.86 mm to 12.75 ± 1.14 mm, after 1 year it was 13.48 ± 1.15 mm, after 2 years — 13.25 ± 3.39 mm. The average density of retinal perfusion increased at the 5th month from 29.81 ± 10.85 % to 31.55 ± 2.34 %, after 12 months to 32.91 ± 3.45, and by the end of the observation period to 31.41 ± 9.79 %. In the DRIL group, the baseline vascular density and mean perfusion volume were significantly lower: 11.17 ± 2.09 mm vs. 13.49 ± 1.14 mm and 28.40 ± 4.53 % vs. 31.20 ± 2.44 %). Conclusion. DRIL, a biomarker reflecting impaired capillary blood flow in the superficial capillary plexus and correlating with functional results, can be used as a predictor of antiangiogenic therapy effectiveness. After antiangiogenic therapy with DMO, the microcirculation indices (FAZ and acircularity) remained stable, and the vascular density and perfusion volume tended to increase, which testifies to the absence of ischemic damage.

Background. Diabetic macular edema (DME) is one of the main causes of decreased central vision. Determining the reasons for the refractoriness of DME to treatment is an urgent problem.Aims. Based on the analysis of optical coherence tomography, to study the features of pathological changes in the retina and vitreoretinal interface (VRI) in the macular zone in patients with DME.Materials and methods. We studied 587 patients (587 eyes) with diffuse DME in the setting of nonproliferative diabetic retinopathy. In addition to the standard ophthalmological examination, everyone underwent optical coherence tomography of the macular zone with an assessment of structural changes in the retina, morphometric parameters, and the state of the VRI.Results. In 351 patients (59.80 %) with DME, pathological variants of the VRI were revealed, in which the best corrected visual acuity was significantly lower, and the morphometric parameters (retinal thickness and macular volume) were signifi cantly higher. Analysis of morphostructural changes in the macular zone revealed that in pathological VRI, neuroepithelial detachment and high edema are more common, and cystic edema is larger in area compared to the group with a normal VRI. With detachment of neuroepithelium against the background of a pathological VRI, the worst morphometric data are determined, with solid exudates in the macula, the worst indices of visual loss are determined.Conclusions. The pathological VRI in patients with diabetic macular edema occurs in more than half of the cases and is characterized by a high incidence of neuroepithelial detachment, high edema, higher morphometric parameters with worse visual acuity. At the same time, the presence of neuroepithelial detachment corresponds to the worst morphometric indicators of the macular zone, and the presence of solid exudates corresponds to a lower maximum corrected visual acuity. Further research is needed to assess the effect of the listed morphostructural and morphometric changes in combination with various pathological variants of VRI on the effectiveness of DME treatment.

Diabetes mellitus (DM) is one of the most common and rapidly progressing diseases worldwide. Diabetic retinopathy (DR) is a common complication of diabetes and the main cause of vision loss in middle-aged and elderly people. The development and progression of DR is closely related to the duration of diabetes, hyperglycemia, and arterial hypertension. There is growing evidence that inflammation is one of the key links in the pathogenesis of diabetic retinal damage, but the exact molecular mechanisms remain to be known. Pancreas transplantation (PT) is currently the only effective treatment for diabetes that restores normal physiological glucose metabolism. Due to the limited number of PT surgeries associated with the severity of intra- and postoperative complications and the acute issue of organ donation, studies on the assessment of DR after PT are few and contradictory. There is a need for further studies of the DR state after PT with the study of the influence of risk factors, determination of the level of immunological markers and the use of modern instrumental research methods to create effective patient management regimens in the postoperative period.

Diabetic retinopathy (DR) is a socially significant disease with a steady tendency to increase, in which there is a high risk of disability due to persistent loss of vision. There are three main pathogenetically substantiated methods of DR treatment: laser coagulation of the retina; intravitreal injections of VEGF inhibitors, steroid drugs; vitreoretinal surgery. In the later stages of DR, vitrectomy is the main method of its complications treating, but there is no clear understanding of the timeliness of this operation. The analysis of the results of original research on this problem is carried out. It has been shown that with the advent of new instruments, modified vitrector, operating microscopes, viewing systems and vitreoretinal combines, vitrectomy led to a change in the paradigm of DR treatment. These advances have resulted in better surgical control and greater precision, while at the same time shorter surgical times and fewer surgical complications. There is a tendency to perform vitrectomy at earlier stages of DR, which has a pathogenetic rationale. This could be a leap forward in the treatment of DR as a preventive measure against the development of proliferative DR.

Purpose:to evaluate the clinical efficacy of anti-VEGF therapy of patients with diabetic macular edema (DMO) in T & E regimen for 96 weeks. Materials and methods. The study included 59 patients (101 eyes) with DMO. The average number of intravitreal injections of anti-VEGF agent (IIAVA) — aflibercept given during the whole period was 12.87 ± 3.56, including 7.78 ± 1.20 in the first year, and 4.82 ± 2.66 in the second year. Results.All patients showed an increase in visual functions (+0.33, p < 0.001) with a maximum achieved after 5 injections (+0.24; p = 0.001). Central macular thickness decreased from 397.36 ± 100,00 μm at the initial level to 276.59 ± 52.90 after 5 loading injections (-120.8 μm), to 263.85 ± 45.20 (-133, 91 μm) after 1 year and to 248.6 ± 46.9 (-148.76 μm) after 2 years. A resorption of retinal neuroepithelial detachment was observed in 84.16 % of cases as soon as loading injections were given, and reached 100 % of cases by the 48th week of observation. Strong inverse correlations were revealed between the initial presence of medium and large intraretinal cysts and visual acuity, both initial and final (-0.35 and -0.42, p < 0.01). The disorganization of retina inner layers at the initial level was a predictor of a worse visual outcome at the end of the observation period. By the end of this period, 44 patients (43.5 %) received IIAVA with an interval of 12 weeks, the maximum interval between injections was 16 weeks and was achieved in 19 (28.01 %) eyes. Conclusion.The results of a 2-year retrospective study of the efficacy of aflibercept in DME showed that T&E regimen can be used with highfunctional results. Due to flexible planning of the number of IIAVA in the second year, over-treatment could be avoided without reducing the expected efficacy.

Introduction and purpose. Diabetes is one of the underlying causes of blindness and other long-term negative consequences that significantly affect patients’ quality of life. The study aimed to determine the indicators characterizing the pathogenetic mechanisms of the development of vascular dysfunction, in particular diabetic retinopathy (DR), and the relationship of these changes with nitric oxide. Material and methods. There were 2114 patients with various surgical diseases under observation (including 1073 patients with purulent-septic soft tissue diseases), among them there were 193 patients with type 2 diabetes mellitus (DM) and 134 patients with Wagner stage 2-5 diabetic foot syndrome (DFS) and diabetic retinopathy in the main group (268 eyes). The comparison group included 59 patients (118 eyes) of the corresponding age with DM without DFS and DR. Both groups were the same in age and gender. Results. The level of the end products of nitric oxide metabolism in peripheral blood was found to be 1.78 times (puperoxide dismutase (SOD) in patients with DR was by 1.56 times (pacid (TBA)-active products in the peripheral blood of patients of the main group exceeded by 1.58 times (p Conclusions. The findings show that the patients with diabetes mellitus complicated by retinopathy and DFS had a significant increase in the content of nitric oxide in the peripheral blood, the cause of which is hyperglycemia. The use of an intercellular mediator (nitric oxide), which contributes to the physiological regulation of the hemodynamics of the eye, protects vascular endothelial cells from pathogenic factors of ischemia, will help clinicians choose an effective pharmacological therapy appropriate for a particular patient and a particular eye.

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The purpose of this study was to investigate the therapeutic effects of 670 nm irradiation in patients with diabetic macular edema. In several studies, positive effects of red/near-infrared irradiation showed in a range of ocular diseases such as macular degeneration, macular edema, and retinitis pigmentosa. This study was conducted on forty five eyes of 26 diabetic patients with macular edema between the ages of 51 and 80.Measurement of visual acuity and slit lamp examination, funduscopy, and optical coherence tomography were performed in all subjects. None of the patients had proliferative retinopathy. We used a portable LED device (Warp 10, Quantum Devices) for treatment. Patients held this device at a distance of 3 cm from their eyes for 240 seconds for three months. Full ophthalmic examinations were repeated 1, 2, and 3 months after treatment.After 3 months, the mean visual acuity improved from 0.44 ± 0.38 log MAR to 0.27 ± 0.24 log MAR and vision increased by 1.52 ± 1.16 lines post treatment (р0.05). Photobiomodulation can positively affect diabetic macular edema, especially in patients with mild to moderate diabetic retinopathy.

Diabetic macular edema (DME) continues to be an important problem of modern ophthalmology and endocrinology. The risk of edema is higher in patients with type 2 diabetes. Thus, this is the main cause of irreversible vision loss in these patients. DME is one of the prognostically unfavorable and difficult to treat manifestations of diabetic retinopathy. As the main cause of vision loss in diabetic patients, diabetic macular edema is often not diagnosed immediately, which causes difficulties in the treatment of pathology. Thus, early diagnosis and timely treatment of this disease is the key to successfully counteract the uncontrolled decline in the patient’s visual functions. In this article, the team of authors highlighted the possibilities of informative instrumental research methods available in the Arsenal of modern ophthalmological services. Based on the analysis of modern literature, the main principles of these diagnostic methods were indicated, their key capabilities and limitations compared to each other were highlighted. Knowledge of these characteristics is, in our opinion, an integral and most important tool in the Arsenal of a practicing ophthalmologist who supervises patients with this pathology.

A data analysis on the actual direction of biomedicine, the study of biomarkers in diabetic retinopathy (DR), was done. Biomarkers identification is important for screening, diagnosis, monitoring, prevention and prediction of the clinical response of the patient to the treatment. In addition, studying the biomarkers allows increase of the effectiveness and safety of using various treatment options. The review examines two main groups of biomarkers, molecular and visualised, which shows the current state of the problem and the prospects for studying biomarkers in the context of the DR treatment. Nowadays, searching for and finding new biomarkers is important and will allow us to develop individual treatment regimens for DR and personalised medicine in an interdisciplinary aspect: ophthalmology and endocrinology.

Diabetic retinopathy (DR) is a serious complication of diabetes mellitus (DM). As DR progresses, it could be complicated with a significant decrease or complete loss of vision. It is the leading cause of blindness in the working-age population and, according to global estimates, occurs in one in every three patients with diabetes. DR has been studied for more than 160 years, and the implementation of retinal laser coagulation into clinical practice in the 20th century, and then vascular endothelial growth factor (VEGF) inhibitors in the 21th century, allowed us to influence vascular proliferation in DR and reduce the risk of vision loss from diabetic macular oedema (DME). However, these tools can only stop the progression of DR at the stages with risk of complications with vision loss, and prevention – screenings and the impact on risk factors (hyperglycaemia, arterial hypertension, and dyslipidemia) – remains as the main method of management of DR. Possible new risk factors (hypodynamy, obesity, body weight deficiency, and obstructive sleep apnoea syndrome) attract a lot of attention, and there is ongoing research for early markers of DR in the fundus, which could allow more active influence on the pathological process in its early stages. This review focuses on epidemiology, history of research, proven and possible risk factors, and current and promising approaches to the prevention and treatment of DR, including accurate, less traumatic laser techniques (PASCAL, NAVILAS, and D-MPL), and intravitreal antiangiogenic drugs in studies.

Despite advances in treatment of diabetes eye complications, diabetic macular edema (DME) remains a common cause of vision loss. Until recently, DME treatment was based on a combination of careful metabolic control and the use of laser photocoagulation. This approach helped to stabilize, but not improve visual function. Also, laser coagulation, despite its effectiveness, is considered as destructive and associated with complications method of treatment. Limited treatment options of diabetic retinopathy led to active research of drugs that can affect complex pathogenetic mechanisms of this disease. The current global experience in treatment allows us to state a paradigm shift in the treatment of DME: antiangiogenic therapy (intravitreal injections of vascular endothelial growth factor-VEGF-inhibitors) is now established as first line therapy. Its effectiveness and safety allowed it to sideline retinal laser coagulation, steroid therapy and vitreoretinal surgery. The article describes the current evidence base for use of anti-VEGF therapy, laser treatment and intravitreal steroids in DME. Article provides data on comparative efficacy and possibility of joint use of various methods of treatment as well as comparison of main anti-angiogenic agents and their treatment regimens.

The purpose of the study — to conduct a comparative analysis of structural and functional indicators of the central zone of the retina in patients with diabetic macular edema and epiretinal membrane in the remote period after surgical treatment. Patients and Methods. We examined 97 patients with diabetic macular edema in combination with the epiretinal membrane aged 53 to 68 years (mean age 61 ± 5.4 years). All patients underwent vitrectomy with an internal limiting membrane peeling (ILM). Patients were divided into 3 groups depending on the intravitreal use of an angiogenesis inhibitor. The analysis of the remote anatomical and functional results of patients of different groups during 1 year of observation was carried out. Results. In patients after treatment using the proposed technique, the central retinal thickness was reduced by 16.19 % (p = 0.031) compared with monotherapy and by 11.51 % (p = 0.039) compared with a phased treatment method. Visual acuity significantly increased in the treatment group by the single-step method by 1.53 times (p = 0.024) compared with the group where only vitrectomy was performed, and also 1.44 times (p = 0.029) compared with the delayed administration of angiogenesis inhibitor in avital eye. Patients in all groups have showed an improvement in central photosensitivity 1 month after surgery, followed by a slight decrease in performance. However, by 12 months, the level of central photosensitivity in group 2 was significantly higher than in other groups (p < 0.05). A comparative analysis of the spatial distribution of macular pigment has showed that, along with the development of the pathological process, macular pigments were dispersed in the retinal tissue. On the background of treatment, their concentration was normalized in the central zone of the retina, without increasing the quantitative composition. Conclusion Analysis of the morphofunctional parameters of the retina central section in patients with diabetic macular edema and epiretinal membrane in the dynamics of treatment with various techniques led to the creation of an algorithm for managing patients. It allows to achieve high clinical and functional results in an overwhelming percentage of cases and, thereby, significantly improve medical and social rehabilitation, and also the quality of life of this contingent.

Cytokines are polypeptides which are produced by a broad range of cells of the body. They play a key role in the formation and regulation of protective reactions. The researchers attempt to find predictors for the development of exudative-inflammatory reaction after surgery. It led to study of the eyes immunological status. It is known that a change of the pro- and anti-inflammatory cytokines balance leads to the blood-ocular barrier dysfunction that increases the inflammatory reaction. It is interesting the blood-ocular barrier has already damaged in diabetic patients. The paper examines the epidemiology, pathogenesis and possible methods of prevention the postoperative cystoid macular edema, presents investigations describing the change in the local cytokine status in patients with diabetes and the association between cytokines concentrations and the severity of diabetic retinopathy. The manuscript has shown possibilities of multiplex analysis, emphasized the features of individual cytokines and angiogenic factors, highlighted cytokines as predictors of macular edema after cataract surgery. The study of the cytokines role in the development of ophthalmic pathology led to the creation the new pathogenetically oriented eye diseases therapy. Further studies of the cytokine status in patients with macular edema after phacoemulsification are needed to determine the possible treatment methods.

Purpose. To assess the effectiveness and safety of intravitreal aflibercept injections in clinically significant diabetic macular edema (DME) in a routine clinical practice.Material and methods. This was a prospective, observational, single-center study. During the study, anti-VEGF treatment naïve patients with clinically significant DME received five monthly intravitreal injections of aflibercept 2 mg followed by bimonthly injections. The observation period was 1 year.Results. The study included 11 eyes of 10 patients with clinically significant DME. Use of 8 intravitreal aflibercept injections resulted in central retinal thickness (CRT) reduction by 50 % from the baseline within 1 year of therapy. CRT decreased on average from 446.18 ± 106.88 μm to 226.27 ± 44.56 μm by the end of observational period. In addition, an increase in visual acuity was observed from an average from 0.33 ± 0.22 at the start of therapy to 0.62 ± 0.33 at the end of the observation. Serious adverse events over the entire period of treatment were not observed.Conclusion. Aflibercept showed high efficacy and safety in the treatment of clinically significant DME in routine clinical practice. To obtain optimal functional and morphological results in the treatment of patients with DME, it is necessary to start therapy with 5 loading intravitreal aflibercept injections.

Diabetic cataracts in combination with diabetic macular edema (DME) is a leading cause of vision loss i n patients with diabetes mellitus.Purpose. To evaluate the efficacy and safety of one-stage combined treatment of patients with diabetes complicated by DME and cat aract.Material and methods. This study involved 16 patients with diabetes of the type 2 (32 eyes). The main group included 16 eyes with complicated cataracts, who underwent the simultaneously performed phacoemulsification of cataract (FEC) with IOL implantation and intravitreal implantation of the «Ozurdex» implant. The second (retrospective control) group included 16 fellow eyes, where a standard FEC with IOL implantation was performed.Results. Six months after the treatment, the main group showed a BCVA stabilization at a level 0.25±0.12 (0.1-0.4). In the retrospective group, the BCVA decreased and reached a baseline level 0.1±0.05 (0.05-0.2), in 5 patients the BCVA became below the baseline values. In all cases in the main group, a partial resorption of «solid» exudates was observed in the macular area. Edema of the retina decreased by 102-275 microns in comparison with preoperative indicators, the average retinal thickness was 385±58 microns in fovea area. Diffuse macular edema with a deposition of «solid» exudates remained in the retrospective control group, all patients had an increase in the amount of intra-etinal hemorrhages. In 5 patients, not only an increase in the number of «solid» exudates was revealed in the dynamics, but also their spread to the fovea region, in 3 cases the exudation foci acquired the form of hyper-reflective layers. The increase in the edema height occurred in all cases by 74-144 microns, index of average retinal thickness was 598±76 microns. In 7 cases, the dynamics showed an increase in flat subfoveal detachments of the neurosensory retina.Conclusions. The complex effect of the OzurDex drug in the combined treatment of diabetic cataracts in combination with DME reduces a risk of inflammatory complications in the early postoperative period, and also provides a reduction in the height of edema and partial resorption of «solid» exudates.

The aim of the study was to elucidate the reactivity of platelets (PL) in the progression of diabetic maculopathy (DMP) with moderate and severe stages of non-proliferative diabetic retinopathy (NDPR) and development of diabetic macular edema (DME). Object and methods of investigation. The study included 29 patients (29 eyes) with diabetes mellitus (DM) of type 2 who, according to the results of the clinical and instrumental examination and according to the ETDRS classification, detected DMP with moderate (18 patients, 18 eyes) and severe (11 patients, 11 eyes) NPDR. For the study of PL in vitro, agonists involved in the pathogenesis of DM 2 type: adenosine diphosphate (ADP), epinephrine, angiotensin-2 (Ang-2), platelet activating factor (PAF), and collagen were used in vitro. The PL aggregation was evaluated by the turbidimetric method using the ChronoLog analyzer (USA). Results of the study. In patients with DMP with moderate and severe stages of NPDR, PL hyperreactivity was observed with respect to collagen, epinephrine, Ang-2 and PAF. The risk factor for the progression of DMP was an increase in the activity of the purineergic retinal system, which was manifested by an increase in the reactivity of adenosine receptors to ADP. The severity of the activation of the renin-angiotensin system and the inflammatory response, which was manifested by the hyperreactivity of PL in response to Ang-2 and PAF, was the reason for the development of DME. Conclusions. In the progression of DMP, activation of sympathetic-adrenal and renin-angiotensin systems, inflammation and remodeling of the intercellular matrix of retinal connective tissue, manifested itself in the growth of PL functional activity, capable of reproducing thrombosis and inflammation in the retina of the eye. Hyperreactivity of PL in response to Ang-2 and PAF was the reason for the development of DME, and, consequently, the sensitivity of AT1- and PAF-receptors of PL can be used to predict the development of DME.

The paper focuses on the diagnostic value of 3D-CTAG in express testing and dynamic self monitoring of treatment of macular diseases. We examined 165 patients (244 eyes) divided into 5 groups: group 1 - 92 patients with dry AMD; group 2 - 43 patients with wet AMD; group 3 - 28 patients with a fibrous scar; group 4 - 31 patients with diabetic macular edema and group 5 of 50 patients who served as control. The standard examination of all patients were supplemented by 3D-computer threshold Amsler grid test (3D-CTAG), microperimetry, optical coherent tomography (OCT), and fluorescent angiography (upon indication). The treatment depended on the clinical form of the disease: multivitamins with Lutein and Zeaxanthin, metabolic agents, or inhibitors of vascular endothelial growth factor. The study shows that 3D-CTAG with an improved protocol can be effectively used as a rapid method of detecting disorders of the macular area depending on the type and duration of the disease. Clinical and functional parallels revealed between the changes in 3D-CTAG and the size of CNV corresponded to a change in brightness sensitivity seen in microperimetry and were confirmed by OCT and fluorescent angiography. // Russian Ophthalmological Journal, 2016; 2: 48-54 . doi: 10.21516/2072-0076-2016-9-2-48-54 .

The paper discusses the key role of VEGF and PlGF in the pathogenesis of diabetic retinopathy and macular edema and describes the mechanisms of retinal neoangiogenesis under the influence of these factors. An overview of treatment methods of retinopathy and macular edema is given, with a focus on anti-VEGF therapy. Anti-VEGF drugs are listed and compared, taking account of the results of their clinical trials. For citation: Iskhakova A.G., Zolotarev A.V., Viktorov D.A., Toropovsky A.N., Nikitin A.G. The role of vascular growth factors in diabetic retinopathy and macular edema development. Russian ophthalmological journal. 2018; 11 (2): 62-9. doi: 10.21516/2072-0076-2018-11-2-62-69 (In Russian).

Purpose: assess the effectiveness of anti-VEGF therapy given prior to cataract phacoemulsification in preventing the progression of diabetic macular edema. Material and methods. The retrospective study included 15 patients (15 eyes) with type 2 diabetes who underwent cataract surgery. Group 1 included 8 patients who received anti-VEGF therapy before surgical treatment. The last injection of aflibercept was performed no earlier than 2 weeks before the surgery, regardless of central retinal thickness (CRT) increase. Group 2 included 7 patients who did not receive anti-VEGF therapy before surgery. All patients received standard presurgical preparation. The changes in visual acuity and CRT were assessed on days 5 and 14 after cataract extraction. Results. On day 5, the mean increase of visual acuity was 0.34 ± 0.05 in Group 1 and 0.275 ± 0.07 in Group 2. The mean CRT decrease was 47 μm in group 1, while group 2 showed a mean CRT increase of 135 μm. On day 14, the visual acuity was 0.49 ± 0.1 higher than the initial value in group 1, whilst in group 2 it was 0.21 ± 0.07 lower than on day 5. The mean CRT decrease was 80 μm in group 1, while group 2 revealed a 165 μm increase of CRT. Conclusion. Anti-VEGF therapy prior to cataract surgery of patients with diabetic macular edema should become mandatory if CRT has increased, regardless of visual acuity, since visual acuity measurement is impossible due to cloudy lens environments. The use of aflibercept in patients with clinically insignificant diabetic macular edema 1 month before the planned cataract surgery ensures a positive result of visual acuity increase and improvement of anatomical parameters. For citation: Malysheva N.A. The first experience of using anti-VEGF therapy prior to cataract surgery in patients with diabetic macular edema. Russian ophthalmological journal. 2018; 11 (3): 55-61 (In Russian). doi: 10.21516/2072-0076-2018-11-3-55-61

Purpose. To identify the features of macular pigment and sensitivity of the central retina in case of vitreoretinal surgery for diabetic macular edema. Material and methods. Vitreoretinal interventions were performed in 31 patients (31 eyes) with diabetic macular edema combined with vitreomacular traction syndrome. All patients underwent the seamless closed 3-port vitrectomy with peeling of internal limiting membrane using the 25G systems. The analysis of retinal changes was carried out according to results of evaluation of optical density of macular pigment and retinal sensitivity pre- and post-operatively. Results. There was revealed a sharp decrease in the parameters of the optical density of macular pigment (ODMP) associated, apparently, with their screening in case of vitreomacular traction syndrome combined with diabetic macular edema. Vitreoretinal intervention led to an increase in the average optical density of the macular pigment by 50.24% indicating a normalization of vitreoretinal interface. Correlative analysis between the parameters of retinal sensitivity and ODMP showed an average correlation (r=-0.66, p

Nowadays, diabetes mellitus is an important public health problem. Together, population growth, prevalence of obesity, and a sedentary lifestyle has led to an increased number of individuals with diabetes mellitus. Globally, cataracts remain the leading cause of blindness and the second cause of visual impairment among patients with diabetes mellitus. Phacoemulsification with intraocular lens implantation is the standardised surgical technique to treat cataracts. Advances in cataract surgical techniques have significantly decreased the incidence of complications. However, surgery may not be safe, as the risk of complications increases in patients with diabetes mellitus with pre-existing blood–ocular barrier pathology. Cystoid macular oedema is one of the most severe postoperative complications after cataract surgery. It is considered the most important cause of suboptimal visual acuity and strongly affects early recovery. The optimal pharmacological therapy for prevention of CME following cataract surgery in patients with diabetes mellitus continues to be debated and needs further investigation.

Diabetes mellitus is the third most dangerous disease of our time preceded by cardiovascular diseases and oncologic pathology. According to the International Diabetes Federation (January 1, 2016), worldwide approximately 415 million people aged 20–79 years suffer from diabetes. The most significant manifestations of diabetes mellitus are lesions of the retina and blood vessels, which manifest as diabetic retinopathy and macular oedema, which lead to the inevitable loss of vision and disability in patients of working age. The existence of multile diagnostic methods and a broad classification provide an evidence of the complex nature of the pathological process of the macular zone in diabetes mellitus. However, to date, a single, generalised and accepted classification does not exist. Difficulties in the treatment of diabetic maculopathy are attributed to various forms of retinal lesions and ambiguities in the approach used to choose the disease management. It determines the importance of the development of diagnostic methods for the further correction of the standard treatment approach. New directions of surgical treatment allow relying on the best results of diabetic maculopathy treatment.

The aim ofthisworkwasto analyze the intensity of the laser coagulates in the treatment of diabetic macular edema conducted in navigation mode on robotic laser system Navilas. Material and Methods. Retrospective analysis of outpatient cards and photographs of the fundus 20 patients (28 eyes) had been done. The patients had type II diabetes mellitus. We performed laser treatment of diabetic macular edema. There were evaluated 4260 coagulates, of which 0 degree 2166 (50.85%), I degree —525 (12.32%), II degree —747 (15.74%), III degree—498 (11.96%), grade IV — 324 (7.6 per cent). Result. The thickness of the retina before treatment in the area of edema was made 339.72±45.3 urn, and after treatment 346±70 urn, student's t-test 0.7124, a difference of 6.5±57.4. Visual acuity before treatment 0.532±0.3, after— 0.521±0.3mm, student's t-test 0,889. Conclusion. The facts obtained in the analysis suggests that the algorithm of selection of power and the way it adjustments in the course of treatment are the weak point of this technique. Development of new methods, giving the possibility to adjust the power depending on the height of the swelling region of the retina, thereby gaining coagulates strictly necessary for the specific case of intensity, will enable to increase the efficiency and safety of laser treatment.

Diabetic macular edema (DME) is a leading cause of blindness in patients with diabetes. The purpose of the research is to evaluate the effectiveness of treatment of patients with DMOs resistant to the administration of ranibi-zumab, using the intrauritreal implant "Ozurdex". Material and Methods. 66 patients (98 eyes) are examined. All of the patients were divided, into three groups, depending on a stage of a diabetic retinopathy. The patients underwent a complex of examinations: along with traditional methods, optical coherence tomography, fluorescence angiography of the fundus, multifocal electroretinography, determination of the content of VEGF-Aand cytokines in serum were used. Results. According to ОСТ of a retina and a visometry there are differences in efficiency of treatment depending on a condition balance of cytokine. Conclusion. The use of the intrauretic implant "Ozurdex" was more effective in patients with DMO in the stage of p re-pro I iterative diabetic retinopathy and in patients resistant to anti-VEGF therapy.

Purpose: efficacy and safety assessment of hypotensive drugs in patients with combined pathology — primary open angle glaucoma (POAG) and diabetic retinopathy (DR).Methods: Patients with POAG 1, 2, 3 stages comorbid with DR and diabetic macular edema (DME) were alocated into three groups based on the stage of glaucoma and hypotensive therapies. POAG 1 –group treated with selective beta-blockers, POAG 2 — the combination of prostaglandin analogues with selective beta-blockers. In POAG 3 — group used the combination of three IOP-lowering drugs include prostaglandin analogues, selective beta-blockers, and carbonic anhydrase inhibitors. Therapy of DR, DME included three intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors. Visual function, eye hydrodynamics and morphometry of retina and optic disc were evaluated in dynamics.Results: glaucoma monitoring showed no significant increase in intraocular pressure, positive dynamics of tonography during ranibizumab theraphy with use of hypotensive drugs. Combined therapy in patients with POAG 1, 2 improve the visual acuity and perimetric indices MD, PSD testing by Humphrey Field Analyser, reduce edema in the macula and the optic nerve head according OCT.Conclusion: the use of ranibizumab in patients with association of primary open-angle glaucoma and DR, DME is effective and safe then the correct selection of hypotensive drugs.

The incidence of diabetic retinopathy (DR) requiring vitreorentinal surgery is increasing. The search for new effective and safe methods of treatment, the choice of the optimal time for surgery, and the assessment of long-term treatment outcomes are relevant problems., Purpose: This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation., Material and Methods: The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months., Results: Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation., Conclusion: The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.

Diabetic macular edema (DME) is a degenerative disease of the macular area in diabetes mellitus and can lead to vision loss, disability, and significantly reduced quality of life. Faricimab is the only bispecific antibody for DME therapy that targets two pathogenic pathways (Ang-2 and VEGF-A)., Purpose: This study comparatively evaluates the clinical and economic feasibility of faricimab and other angiogenesis inhibitors in patients with DME., Material and Methods: This article analyzed literature on the efficacy and safety of intravitreal injections (IVI) of ranibizumab 0.5 mg, aflibercept 2 mg, and faricimab 6 mg. A model of medical care was developed for patients with DME receiving anti-angiogenic therapy. Pharmacoeconomic analysis was performed using cost minimization and budget impact analysis (BIA) methods. Modeling time horizon was 2 years. The research was performed from the perspective of the healthcare system of the Russian Federation., Results: The efficacy and safety of faricimab in a personalized regimen (up to one IVI in 16 weeks) are comparable to those of aflibercept and ranibizumab, administered in various regimens. The use of faricimab is associated with the lowest number of IVIs. Over 2 years, the maximum costs of drug therapy were associated with the use of ranibizumab (about 914 thousand rubles), while the minimum costs were associated with the use of faricimab (614 thousand rubles). The reduction in inpatient care costs with faricimab therapy was 36% compared to aflibercept (216 and 201 thousand rubles in inpatient and day hospitals, respectively) and 82% compared to ranibizumab (486 and 451 thousand rubles in inpatient and day hospitals, respectively). BIA demonstrated that the use of faricimab will reduce the economic burden on the healthcare system by 11.3 billion rubles (9.8%) over 2 years., Conclusion: The use of faricimab is a cost-effective approach to treatment of adult patients with DME in Russia.

Objective: to analyze the structural state of the central area of the retina in diabetic macular edema in the background anti-VEGF therapy. Methods. The study included 38 patients (40 eyes) with diabetic macular edema. All patients received anti-VEGF-ranibizumab therapy at a dose of 0.05 ml. The results were analyzed after three intravitreal injections with 1 month interval. We assessed visual acuity, morphological and anatomical structure of the macular area, the sensitivity of the retina and macular pigment optical density Results. Analyzing optical density of the macular pigment we revealed a significant increase of all parameters in 73 % of patients after the therapy. The average value of the optical density before treatment was at 0.102 ± 0.01 du, on the background of anti-VEGF-therapy this figure went up to 0.213 ± 0.01 (p < 0.05). According to the optical coherence tomography average retinal thickness before treatment made 404.62 ± 15.23 ßm, after the treatment - 300.91 ± 6.43 ßm (р < 0,05). When comparing data of optical coherence tomography and macular pigment optical density we revealed more pronounced decrease in the macular pigment optical density in the area of the retinal edema and a significant increase in the basic parameters on the background of the therapy. Conclusion. Anti-VEGF-therapy significantly improves visual acuity, the recovery profile of macular edema and reduces the zone in patients with diabetic macular edema.

Background: In diabetic patients with glaucoma, individualized pharmacotherapy of glaucoma is needed. Aim: To assess the effects of topographic morphometric characteristics of macular region and presence of concomitant diseases on visual acuity in patients with diabetes mellitus and glaucoma or ocular hypertension in order to provide optimal drug treatment. Materials and methods: 178 patients with diabetes and glaucoma or ocular hypertension were examined. Results: Background somatic pathology was as follows: arterial hypertension in 92.7% of the patients, ischemic heart disease in 36.2%, dyscirculatory encephalopathy in 96.1%, bronchial asthma in 5.6%, cervical osteochondrosis in 20.2%. 86.7% of the patients had primary chronic open-angle glaucoma, 1.1% – narrow-angle glaucoma, 1.1% – low pressure glaucoma, and 2.2% – secondary glaucoma. Significant diabetic macular edema was found in 85% of cases. Thickness of parafoveola was significantly negatively correlated with corrected visual acuity. Serous retinal detachment was demonstrated in 27.7% of cases, detachment of epiretinal membrane – in 41.7%, cystic changes – in 50% of the patients. Conclusion: In patients with diabetes and glaucoma, hypotensive therapy with prostaglandins may be contraindicated due to background changes of macular region.

Purpose. To evaluate the efficacy of intravitreal injection of Lucentis in the treatment of diffuse diabetic macular edema (DME) associated with pan-retinal photocoagulation in the proliferative diabetic retinopathy (DR).Material and methods. A retrospective study (58 eyes) with a high diffuse DME and proliferative DR was performed in 46 patients with insulin-dependent diabetes mellitus aged 45-73 years (mean age: 59.2±0.9 years). All participants underwent i ntravitreal injection (IVI) of Lucentis pars plana. The pan-retinal photocoagulation (PRPC) stage was performed 2 weeks after each Lucentis IVI. The main criteria were the dynamics of best corrected visual acuity (BCVA), the OCT parameters – in the central retinal thickness (1mm) area and volume of the macula. The treatment efficacy was assessed one month after the final PRPC stage.Results and discussion. At the end of treatment an increase in the average BCVA values from 0.32 to 0.45, a decrease in retinal thickness in fovea zone – from 506.9mm to 394.6mm, in the volume of macula from 12.9 to 11.6mm3 were noted. Stabilization or an increase in initial visual acuity was observed in 83.4%. The initial thickness of the retina in the region of 1mm was reduced from 506.9mm to 394.6mm, i.e. decreased by an average of 22%. The stabilization of visual functions was achieved more than in 80% of cases one month after the combi ned treatment.Conclusions. The performed retrospective study showed an efficacy of intravitreal injection of Lucentis to stabilize visual functions, to reduce the height of macular edema during the pan-retinal photocoagulation in patients with proliferative diabetic retinopathy.

Aim. To assess morphological changes of retinal layers and optical density of macular pigment in patients with diabetic macular edema (DME) for the diagnostic criterion of pathological process.Materials and methods. 31 patients were divided in two groups. The first group (A) included 19 patients with DME (20 eyes), the second group (B) – 12 patients (20 eyes) without retinal pathology. Both groups were comparable with regard to age. Parameter estimation was conducted with the use of following methods: optical coherence tomography (OCT) of the macular area of the retina; fundus photography with the measurement of macular pigment optical density (MPOD); microperimetry.Results. OCT analysis showed that the inner nuclear and plexiform layers of retina were the most involved in pathological process and revealed significant differences in increase of mean retinal thickness in comparison with the control group. Analysis of MPOD revealed a significant reduction of all parameters in group A compared with the control group. On the basis of microperimetry of the central area of retina in group A light sensitivity indicators were reduced by an average of 9 dB and equaled 9.85 ± 0.09 dB. The analysis showed gross violations of retinal structure and distribution of optical density of macular pigment in patients with DME. Correlation analysis of retinal thickness, functional light sensitivity and optical density of macular pigment traced a strong connection (r = -0.93; p

Glaucoma and diabetic retinopathy (DR) are the most frequent reasons of visual loss and disability. Combination of glaucoma and DR causes worse prognosis. Similarity of pathogenetic mechanisms of DR and glaucoma allows consideration of more frequent development of primary open-angle glaucoma among patients suffering diabetes mellitus. To reveal these diseases at the earliest stages is one of the most difficult ophthalmological problems. The contemporary methods of DR and glaucoma diagnostics are optical coherence tomography and Heidelberg retina tomography. They give an opportunity to estimate the dynamics of pathological process and the efficiency of surgical and pharmacological treatment. Optical scanning of an optic disk and peripapillary retina gives a chance to estimate up to 20 morphometric parameters. Determination of retinal nerve fiber layer (RNFL) thickness in peripapillary zone reflects a condition of nerve fibers and extent of their defeat. It is shown that in glaucoma there is a thinning of RNFL and a neuroretinal rim. In early diagnostics of glaucoma the parameters of optic disk characterizing neuroretinal rim are considered the most informative. OCT considerably expands diagnostic research possibilities of structural and morphological retinal changes in a macular zone in patients with DR and DME. Measurement of retinal thickness in macular area is a key point in diagnostics and tactics of treatment. The standard method of DR therapy is retinal laser coagulation. However, laser photocoagulation as monotherapy is not effective enough in patients with diffuse and cystoid macular edema. It is more reasonable to use retinal laser photocoagulation in combination with antiangiogenic therapy for treatment of the diabetic macular edema (DME) and DR. The special emphasis is put on development of treatment algorithm of combination of glaucoma and diabetic retinopathy. Therapy of neovascular glaucoma in patients with diabetes mellitus type 2 is a complex problem. Such patients traditionally get panretinal laser photocoagulation. Recently anti-VEGF-agents are used as additional therapy of neovascular glaucoma. However, nowadays the influence of antiangiogenic treatment on dynamics of clinical and morphological parameters in patients with the combined pathology is insufficiently investigated.

Purpose: To evaluate of retinal morphology and function progress in patients with diabetes type 2 and DME consistent with the level of pathogenetic factor in tear fluid.Methods: The progress of visual acuity, retinal thickness and photosensitivity after ranibizumab intravitreal injection has been assessed.Results: Statistically significant increase in visual acuity, retinal photosensitivity, decrease of retinal thickness and VEGF A level was found in the tear fluid after injection. The correlation of VEGF level in tear fluid with visual acuity after procedure was found to be negative. Conclusion: Ranibizumab intravitreal injection is a pathogenic treatment leading to morphological and functional retinal state improvement.

Development of late microvascular complications — diabetic retinopathy, nephropathy and neuropathy — in type 2 diabetic pa- tients is associated with higher invalidization risk and lethality. Diabetic retinopathy is the leading cause of blindness in people of work- ing age in developed countries. Classical approach to diabetic retinal damage pathogenesis is widened and considered at the molecular level in terms of cell interactions during angiogenesis. In this literal review the actual epidemiological data is presented along with therole of angiogenic factors in diabetic retinopathy and maculopathy pathogenesis.

Diabetic macular edema (DME) is a common complication associated with the loss of visual acuity in diabetic patients. Intravitreal injections of vascular endothelium growth factor (VEGF) inhibitors (anti-VEGF therapy) have been proposed recently as a new treatment option for patients with DME. In this review we summarized results of randomized clinical trials of VEGF inhibitors in DME patients. The results indicate that all studied inhibitors (ranibizumab, bevacizumab, pegaptanib and aflibersept) reduce the retinal thickness and improve of visual acuity in DME when are used as a monotherapy or in combination with the laser treatment. Optimal course duration and effectiveness predictors of anti-VEGF therapy in DME should be elucidate in the future studies.

Introduction. Diabetic macular edema (DME) is a common manifestation of diabetic retinopathy and an important cause of visual impairment in people with diabetes. DME is the most common cause of decreased vision in patients with diabetes. It can accompany any stage of the disease and occurs on average 10% of patients with diabetes. In this case, due to structural changes in the endothelium of retinal vessels violation of the retinal barrier increased permeability of blood vessels wall and fluid accumulation in the intercellular space retinal optical coherence tomography (OCT) is a method of diagnostic morphological structure of the retina and allows high precision of the DME diagnose, assess the severity and observe the dynamics. Materials and methods. During the work general ophthalmic examination, OCT, PAH and immunological studies were performed in all patients. Total 64 patients (128 eyes), including 28 women (43.8%) and 36 men (56.3%), whose average age was '58 (SD 10), 24 to 78 years with diabetes type II diabetic macular edema of various kinds took part in the study. Diffuse (occlusal and unocclusal kind ) and complicated (occlusal and unocclusal ) DME were studied. Diffuse occlusal DME was diagnosed in 33 cases, diffuse unocclusal DME – in 35 cases, complicated occlusal DME - in 28 cases, complicated unocclusal DME - in 32. Statistical analysis was performed in the program MedCalc 9.0. Results and Discussion: In this clinical study there is a clear pattern between the type and the presence of DME. Conclusions: We can talk about the use of the criterion of the presence or absence of RPE detachment to differentiate species (occlusion or unocclusual) diffuse and complicated DME in patients with diabetes type II.